In 2018, India launched the Anemia Mukt Bharat (AMB) program aimed at reducing the prevalence of anemia among children, adolescents, pregnant and lactating women, and women of reproductive age. Enhancing reporting mechanisms and leveraging data strategically for effective implementation are integral to the AMB program. Nutrition International – leading global nutrition organization working in Chhattisgarh for the past 15 years along with the National Health Mission, Chhattisgarh has led the effective reporting and Health Management Information System (HMIS) integration of AMB program, resulting in improvement in key indicators of the program. One of the key initiatives was of Block Ranking Exercise which has strengthened reporting and data collection at the field level.
Block Ranking Exercise
The Block Ranking Exercise (BRE) is an initiative aimed at assessing the performance of the AMB program at district and block level and supporting the state National Health Mission to strengthen the program.
In 2020, Nutrition International piloted BRE in 12 districts of Chhattisgarh. Under this initiative, a scorecard was created for the intervention districts. Scores were based on select critical process indicators such as coordination committee meetings, reporting, availability of supplies, and much more that were directly related to output indicators of the AMB program, that is, the coverage of Iron and Folic Acid (IFA) tablets.
Field coordinators were also trained for creating district-specific scorecards on a monthly basis, which were used by the field team during advocacy meetings with district authorities and then shared with nodal officers for taking corrective actions in the program. In addition, BRE was also conducted to identify bottlenecks and solutions in the intervention districts to improve the implementation of the AMB program.
The findings and positive outcomes of the pilot phase of the BRE initiative show that BRE has helped in developing different strategies according to the score of a particular component and thereby address the program implementation issues appropriately. Looking at the success of the pilot phase, Nutrition International has been advocating for scaling the initiative across all the 28 districts of Chhattisgarh.
Key outcomes of the initiative
Through the BRE, districts are now able to review the AMB indicators regularly. As a result, gaps in reporting have been identified in real-time and corrective actions have been taken. Regular training at all levels has helped build the capacity of field functionaries in reporting formats and processes, with a focus on accuracy in reporting and quality of data. With this rigorous reporting and close monitoring, improvement in the State’s AMB scorecards is evident. The average scoring of districts has improved by approximately 13.25 points (table 1) in a span of 07 months. The highest improvement has been observed in Kanker district where the AMB score improved by 28 points.
Table 1: AMB scores of intervention districts across months
| <=26 | Low performing |
| 27-50 | Medium Performing |
| >51 | High performing |
Nutrition International and the AMB program team in Chhattisgarh have built on the knowledge of the gaps in data management from previous IFA supplementation programs. Consequently, data management has been identified as an integral part of the AMB implementation plan. From figure 1, it is evident that with the advent of BRE, the coverage of IFA among the intervention districts increased significantly in comparison to non-intervention districts.
“This is a classic case of planning supported by extensive training programs with an emphasis on recording and reporting of data at the field level. The effective collaboration of NHM Chhattisgarh with Nutrition International helped in building capacity across the blocks, districts, and state levels for reporting and management of data. As a result, the state’s AMB scores have improved. We are delighted to support the BRE initiative.”, said Dr. V.R. Bhagat, State Programme Officer, Anemia Mukt Bharat & Child Health, Directorate of Health Services, Nawa Raipur, Chhattisgarh.
The Block Ranking Exercises initiative demonstrates how district-level data can help in effective decision-making to improve programmatic delivery. Subsequent reports from BRE can strengthen the overall AMB program by making a significant impact at the field level.
